Lancet Diabetes Endocrinol

Diabetes drug combo improves CV, renal outcomes

July 19, 2024

Combining SGLT2 inhibitors with GLP-1 receptor agonists appears to provide added protection against heart and kidney disease in patients with diabetes. The findings of this meta-analysis support clinical practice guidelines recommending use of these agents in combination to improve CV and kidney outcomes.

• This collaborative meta-analysis of 12 trials in the SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium (SMART-C) examined whether the benefits of SGLT2 inhibitors are consistent in patients receiving and not receiving GLP-1 receptor agonists. The two main CV outcomes assessed were MACE and hospitalization for heart failure or CV death. The main kidney outcomes assessed were CKD progression (≥40% decline in eGFR, kidney failure [eGFR <15 mL/min/1.73 m^2, chronic dialysis, or kidney transplantation], or death due to kidney failure), and rate of change in eGFR over time.
• In total, 82.1% of the 89,183 participants had diabetes and of those, 4.2% were using GLP-1 receptor agonists at baseline. SGLT2 inhibitors reduced MACE risk in participants both receiving and not receiving GLP-1 receptor agonists (hazard ratios [HRs], 0.81 vs. 0.90). Effects on hospitalization for heart failure or CV death (0.76 vs. 0.78) and CKD progression (0.65 vs. 0.67) were also consistent regardless of GLP-1 receptor agonist use, as was the effect on the chronic rate of change in eGFR over time.
• Fewer serious adverse events occurred with SGLT2 inhibitors compared with placebo, irrespective of GLP-1 receptor agonist use (relative risk, 0.87 vs. 0.91).

Source:

Apperloo EM, et al. (2024, July 8). Lancet Diabetes Endocrinol. Efficacy and safety of SGLT2 inhibitors with and without glucagon-like peptide 1 receptor agonists: a SMART-C collaborative meta-analysis of randomised controlled trials. https://pubmed.ncbi.nlm.nih.gov/38991584/